ACL Reconstruction Graft Options

This is the most common type of graft used in ACL reconstruction. Autografts are generally associated with a lower risk of infection and graft rejection because they come from your body. The three most common autograft options are:

Bone-Patellar Tendon-Bone (BTB): This graft is harvested from the central portion of the patellar tendon (the tendon in front of the knee) and includes small pieces of bone on each end. It is a popular choice for athletes due to its strong fixation and faster incorporation.

Advantages: High success rate, strong fixation, and potentially faster healing time because it involves bone healing to bone. Historically has the lowest chance of re-tear.

Disadvantages: Some people suggest that patients may have increased front of knee pain after ACL reconstruction surgery, particularly with kneeling. There is also a very small risk of patellar tendon complications, and slightly longer surgery time. There is also a very small risk of a patella fracture if the bone taken from the knee cap does not fill in. It is also a larger incision on the front of the knee than the other options.

Quadriceps Tendon: This graft is becoming very popular lately, and is harvested from the quadriceps tendon (the tendon above the kneecap). It is a very good option and data shows it to be similar to patella tendon

Advantages: Strong graft with good fixation, lower risk of patellar tendon complications, and slightly less postoperative pain compared to BTB grafts.

Disadvantages: Does not have bone to bone healing, may have a slightly higher chance of stiffness after surgery, longer term data is not yet available.

Hamstring Tendon: Historically this was a very popular graft. This graft is taken from the hamstring tendon (the tendon behind the knee). However, it has been shown to be less successful than patella tendon or quadricep tendon.

Advantages: Less postoperative pain, lower risk of patellar tendon complications, and suitable for patients with open growth plates.

Disadvantages: Longer healing time, less rigid fixation compared to BTB grafts, higher failure rate.

These grafts are harvested from a deceased donor. Allografts are a good option for older patients, patients who need multiple ligament reconstructions or revisions and for those who want to avoid the potential pain associated with autograft harvest. It should not be used for younger patients as it has a significantly higher failure rate.

Advantages: Less postoperative pain and shorter surgery time as there’s no need to harvest your own tissue.

Disadvantages: Slightly higher risk of infection and graft failure. There may also be a longer healing time due to slower integration of the graft. There is a much higher rate of failure if used in young patients.

The BEAR procedure is a novel, alternative option to traditional ACL reconstruction. Instead of replacing the torn ligament with a graft, the BEAR technique involves using a bio-engineered scaffold to stimulate the body’s natural healing process and repair the torn ligament.

Advantages: Preservation of the native ACL, potential for faster recovery, and less invasive than traditional reconstruction.

Disadvantages: Not widely available and still under investigation for long-term outcomes and efficacy.